The New England States Collaborative For Insurance Exchange Systems: Supporting Massachusetts and National Health Reform Through Technology Innovation

Project Goal: To create Health Insurance Exchange (HIX) Information Technology components in Massachusetts that are consumer-focused, cost-effective, reusable, and sustainable and that can be leveraged by New England and other states to operate Health Insurance Exchanges. The NESCIES project approach will be to create and build a flexible HIX Information Technology framework in Massachusetts designed to connect consumers, small businesses, and health plans that can be tailored to the needs of the New England states and beyond.Achieving this goal will require the creation of solutions that are component based, adaptable, and based on the standards required by the ACA

Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems

Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

Introduction: Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs\u27 impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs. Methods and analysis: The study\u27s four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research\u27s (CFIR) serves as the study\u27s conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations). Discussion: Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs. Ethics and dissemination: IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership

Any health care reform must allow continuation of robust Medicaid Buy-In programs for working people with disabilities

National health care reform must meet the unique health care needs of people with disabilities. However, obtaining health care coverage for a person with disabilities can be challenging in an employer-based health insurance environment. The final healthcare reform act must ensure that working people with disabilities retain the options they currently have to participate; any legislation should embed Medicaid Buy-in cocerage and provide states the flexibility they need to support individuals with disabilities in employmen

How Do Employment Outcomes of Medicaid Buy-In Participants Vary Based on Prior Medicaid Coverage? An Example from Massachusetts

Summary: The Medicaid Buy-In program is a key component of the federal effort to make it easier for people with disabilities to work without losing health benefits. Authorized by the Balanced Budget Act of 1997 (“BBA”) and the Ticket to Work and Work Incentives Improvement Act of 1999 (“Ticket Act”), the Buy-In program allows states to expand Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid. To be eligible for the program, an individual must have a disability (as defined by the Social Security Administration) and earned income, and must meet other financial eligibility requirements established by states. States have some flexibility to customize their Buy-In programs to their specific needs, resources, and objectives. As of July 1, 2008, 33 states with a Medicaid Infrastructure Grant (MIG) reported covering 82,488 individuals in the Medicaid Buy-In program. The CommonHealth Working (CHW) program in Massachusetts is the oldest Buy-In program in the nation. It began in 1988 as a state-funded program and was folded into the state’s 1115 Medicaid research and demonstration project in 1996. This issue brief, the eighth in a series on workers with disabilities, compares the employment outcomes of newly enrolled CHW participants based on whether or not they were previously enrolled in MassHealth, Massachusetts’s Medicaid program, under another eligibility category. For those who had been enrolled in MassHealth, employment outcomes before and after CHW enrollment are contrasted

Advancing the university mission through partnerships with state Medicaid programs.

State Medicaid programs are playing an increasingly important role in the U.S. health care system and represent a major expenditure as well as a major source of revenue for state budgets. The size and complexity of these programs will only increase with the implementation of the Patient Protection and Affordable Care Act. Yet, many state Medicaid programs lack the resources and breadth of expertise to maximize the value of their programs not only for their beneficiaries but also for all those served by the health care system.Universities, especially those with medical schools and other health science programs, can serve as valuable partners in helping state Medicaid programs achieve higher levels of performance, including designing and implementing new approaches for monitoring the effectiveness and outcomes of health services and developing and sharing knowledge about program outcomes. In turn, universities can expand their role in public policy decision making while taking advantage of opportunities for additional research, training, and funding. As of 2013, approximately a dozen universities have developed formal agreements to provide faculty and care delivery resources to support their state Medicaid programs. These examples offer a road map for how others might approach developing similar, mutually beneficial partnerships

Advancing the university mission through partnerships with state Medicaid programs

State Medicaid programs are playing an increasingly important role in the U.S. health care system and represent a major expenditure as well as a major source of revenue for state budgets. The size and complexity of these programs will only increase with the implementation of the Patient Protection and Affordable Care Act. Yet, many state Medicaid programs lack the resources and breadth of expertise to maximize the value of their programs not only for their beneficiaries but also for all those served by the health care system.Universities, especially those with medical schools and other health science programs, can serve as valuable partners in helping state Medicaid programs achieve higher levels of performance, including designing and implementing new approaches for monitoring the effectiveness and outcomes of health services and developing and sharing knowledge about program outcomes. In turn, universities can expand their role in public policy decision making while taking advantage of opportunities for additional research, training, and funding. As of 2013, approximately a dozen universities have developed formal agreements to provide faculty and care delivery resources to support their state Medicaid programs. These examples offer a road map for how others might approach developing similar, mutually beneficial partnerships

Assessing Health Care Reform: Potential Effects on Insurance Coverage Among Persons With Disabilities

The changes enacted by the Patient Protection and Affordable Care Act are designed to substantially increase health insurance coverage. The authors analyze the health care reforms to assess the potential for increased insurance coverage among persons with disabilities. They estimate that approximately 2 million persons with disabilities will be newly insured; however, they also find a probable unintended consequence of the health care reforms: that some persons with disabilities will lose their current Medicaid coverage. The article outlines policy changes that would prevent this unintended consequence before full implementation of the changes in 2014